Take-away from new breast cancer screening guidelines: It's personal

April 21, 2015
| by Nicole White

In light of the new breast cancer screening guidelines, which call for women to have mammograms every other year from age 50 to 74, it's more important than ever for women to understand their individual risk.

New breast cancer screening guidelines call for women age 50 to 74 to have mammograms every other year.

On Monday, the U.S. Preventive Services Task force released new breast cancer screening guidelines that are a clear withdrawal from one-size-fits-all screening. For women at "average risk," every other year from 50 to 74 seems to be the window that has the most benefit and least harm. For women at increased breast cancer risk, the guidelines say that earlier and more frequent screening should be considered.

"There is a push to advocate for the general population to discuss this with their physicians and for clinicians to be more educated – and that's good. It's individualized medicine," said Lusine Tumyan, M.D., chief of breast imaging and assistant clinical professor in the Department of Diagnostic Radiology at City of Hope. "I think radiologists as a community would still like to see annual screening – biennial screening increases the number of cancers we miss. The whole point of screening is to catch the cancers early so we can treat patients early."{C}

The risk of missing cancers can be mitigated if screening is individualized, with women and their doctors studying the woman's individual risk factors and family history, then balancing those facts against the risks associated with screening.

The recommendation from the task force states: "The decision to start screening mammography prior to age 50 is an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years."

In its analysis, the task force found that women age 60 to 69 years old are the most likely to avoid a breast cancer death through mammography screening. Screening women under 50 may reduce the risk of dying of breast cancer, but the number of deaths averted is smaller than in older women and the number of false-positive tests and unnecessary biopsies is higher.

Women with a parent, sibling or child with breast cancer may benefit more from screening beginning at 40 than women of average risk.

The new guidelines are also clear about what the medical community does not know:

The benefits of screening for women older than 75 are unclear.

Not enough study has been done on advanced imaging technologies, such as 3-D mammography, to determine the benefits and harms if used for screening.

Solutions for women with dense breasts are also unclear. Current study doesn't present a clear picture on whether benefits outweigh harms using ultrasound, MRI, 3-D mammography or other methods for these women.

Given these unknowns, it's especially important for women to have a discussion with their doctors about what screening is appropriate. Breast cancer screening and improvements in treatment have played a large role in making this a very treatable cancer – but it remains the third-leading cause of cancer death among women in the United States.

The biggest harms identified are "overdiagnosis and overtreatment," that is diagnosis and treatment of a cancer that would otherwise not have become a threat to a woman's health or even apparent during her lifetime. False-positive tests can result in unnecessary and invasive follow-up tests.

Anxiety is also listed as a harm of mammography.

The bottom line is, like the rest of medicine, cancer screening is evolving from a one-size-fits all approach to highly individualized care. Be sure to talk to your physician about when you should start screening and how often you should be screened to determine what's best for your health.